Frontotemporal Dementia

Frontotemporal dementia (FTD) is a group of degenerative diseases that gradually damage or shrink the front of the brain — the frontal and anterior temporal lobes. These two areas are the center of many important brain functions, including language skills as well as the ability to focus attention, make plans and decisions and control impulses.

FTD affects an estimated 250,000 North Americans, with the average duration of the disease about eight years. Most cases are diagnosed during the 50s and 60s with men and women equally affected. Because FTD often occurs in younger people, it can severely affect families. Patients often still have children living in the home. Financially, it can be devastating as the disease strikes at the time of life that is often the top wage-earning years.

In the past, the disease was confused with Alzheimer’s disease or other forms of dementia. But unlike Alzheimer’s disease, frontotemporal dementia appears earlier in life. As researchers have learned more about the disease, they now believe it is the second leading cause of dementia in middle age.

Early symptoms of frontotemporal dementia typically involve personality or mood changes such as depression and withdrawal, sometimes obsessive behavior and language difficulties. Many patients lose their inhibitions and exhibit antisocial behavior. A small percentage of patients develop extraordinary visual or musical creativity, while experiencing language and social impairment.

Language problems are less common but do occur in the early stages of FTD before other thought processes, such as memory, are affected. Patients may experience difficulty speaking or finding the correct word when naming objects. Difficulties reading and writing then develop. As the disease progresses, less and less language is used, until the patient becomes virtually mute. Other patients may have a severe problem recalling words and understanding word meaning, but continue to have otherwise normal speech.

Early signs of frontotemporal dementia may involve the following symptoms:

  • Apathy or an unwillingness to talk
  • Change in personality and mood, such as depression
  • Lack of inhibition or lack of social tact
  • Obsessive or repetitive behavior, such as compulsively shaving or collecting items
  • Unusual verbal, physical or sexual behavior
  • Weight gain due to dramatic overeating

Patients may neglect hygiene and resist encouragement to attend to themselves. They also may lack awareness or concern that their behavior has changed.

As FTD progresses, it takes a toll on mental abilities, affecting memory and other functions that are more common in Alzheimer’s and other dementias. In Alzheimer’s disease, one of the first symptoms is memory loss. With FTD, unusual or antisocial behavior as well as loss of speech or language are usually the first symptoms.

In later stages, patients develop movement disorders such as unsteadiness, rigidity, slowness, twitches, muscle weakness or difficulty swallowing. Some patients develop Lou Gherig’s disease or amyotrophic lateral sclerosis (ALS). People in the final stages of FTD cannot care for themselves.

There is no known curative treatment for FTD. Supportive care is essential.